A Randomized Controlled Trial of an Internal Family Systems-based Psychotherapeutic Intervention on Outcomes in Rheumatoid Arthritis: A Proof-of-Concept Study

From the Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; Department of Psychiatry, Cambridge Health Alliance, Boston, Massachusetts; Center for Self Leadership, Oak Park, Illinois; and Department of Psychology, Massachusetts School of Professional Psychology, Boston, Massachusetts, USA. Supported by the Bristol Myers Squibb Foundation, ABBVIE, and Genentech. N.A. Shadick, MD, MPH, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; N.F. Sowell, MSW, Department of Psychiatry, Cambridge Health Alliance; M.L. Frits, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; S.M. Hoffman, PhD; S.A. Hartz, RN, MSN, CS; F.D. Booth, MSW, Center for Self Leadership; M. Sweezy, PhD, Department of Psychiatry, Cambridge Health Alliance; P.R. Rogers, MSW; R.L. Dubin, Ed.D; J.C. Atkinson, MSW; A.L. Friedman, MSW; F. Augusto, PhD, Center for Self Leadership; C.K. Iannaccone, MPH; A.H. Fossel, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; G. Quinn, Department of Psychology, Massachusetts School of Professional Psychology; J. Cui, PhD; E. Losina, PhD, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; R.C. Schwartz, PhD, Center for Self Leadership. Address correspondence to Dr. N.A. Shadick, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA. E-mail: nshadick@partners.org. Full Release Article. For details see Reprints/Permissions at jrheum.org. Accepted for publication June 25, 2013.

From the Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; Department of Psychiatry, Cambridge Health Alliance, Boston, Massachusetts; Center for Self Leadership, Oak Park, Illinois; and Department of Psychology, Massachusetts School of Professional Psychology, Boston, Massachusetts, USA. Supported by the Bristol Myers Squibb Foundation, ABBVIE, and Genentech. N.A. Shadick, MD, MPH, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; N.F. Sowell, MSW, Department of Psychiatry, Cambridge Health Alliance; M.L. Frits, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; S.M. Hoffman, PhD; S.A. Hartz, RN, MSN, CS; F.D. Booth, MSW, Center for Self Leadership; M. Sweezy, PhD, Department of Psychiatry, Cambridge Health Alliance; P.R. Rogers, MSW; R.L. Dubin, Ed.D; J.C. Atkinson, MSW; A.L. Friedman, MSW; F. Augusto, PhD, Center for Self Leadership; C.K. Iannaccone, MPH; A.H. Fossel, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; G. Quinn, Department of Psychology, Massachusetts School of Professional Psychology; J. Cui, PhD; E. Losina, PhD, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; R.C. Schwartz, PhD, Center for Self Leadership. Address correspondence to Dr. N.A. Shadick, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA. E-mail: nshadick@partners.org. Full Release Article. For details see Reprints/Permissions at jrheum.org. Accepted for publication June 25, 2013.

From the Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; Department of Psychiatry, Cambridge Health Alliance, Boston, Massachusetts; Center for Self Leadership, Oak Park, Illinois; and Department of Psychology, Massachusetts School of Professional Psychology, Boston, Massachusetts, USA. Supported by the Bristol Myers Squibb Foundation, ABBVIE, and Genentech. N.A. Shadick, MD, MPH, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; N.F. Sowell, MSW, Department of Psychiatry, Cambridge Health Alliance; M.L. Frits, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; S.M. Hoffman, PhD; S.A. Hartz, RN, MSN, CS; F.D. Booth, MSW, Center for Self Leadership; M. Sweezy, PhD, Department of Psychiatry, Cambridge Health Alliance; P.R. Rogers, MSW; R.L. Dubin, Ed.D; J.C. Atkinson, MSW; A.L. Friedman, MSW; F. Augusto, PhD, Center for Self Leadership; C.K. Iannaccone, MPH; A.H. Fossel, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; G. Quinn, Department of Psychology, Massachusetts School of Professional Psychology; J. Cui, PhD; E. Losina, PhD, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; R.C. Schwartz, PhD, Center for Self Leadership. Address correspondence to Dr. N.A. Shadick, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA. E-mail: nshadick@partners.org. Full Release Article. For details see Reprints/Permissions at jrheum.org. Accepted for publication June 25, 2013.

From the Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; Department of Psychiatry, Cambridge Health Alliance, Boston, Massachusetts; Center for Self Leadership, Oak Park, Illinois; and Department of Psychology, Massachusetts School of Professional Psychology, Boston, Massachusetts, USA. Supported by the Bristol Myers Squibb Foundation, ABBVIE, and Genentech. N.A. Shadick, MD, MPH, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; N.F. Sowell, MSW, Department of Psychiatry, Cambridge Health Alliance; M.L. Frits, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; S.M. Hoffman, PhD; S.A. Hartz, RN, MSN, CS; F.D. Booth, MSW, Center for Self Leadership; M. Sweezy, PhD, Department of Psychiatry, Cambridge Health Alliance; P.R. Rogers, MSW; R.L. Dubin, Ed.D; J.C. Atkinson, MSW; A.L. Friedman, MSW; F. Augusto, PhD, Center for Self Leadership; C.K. Iannaccone, MPH; A.H. Fossel, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; G. Quinn, Department of Psychology, Massachusetts School of Professional Psychology; J. Cui, PhD; E. Losina, PhD, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; R.C. Schwartz, PhD, Center for Self Leadership. Address correspondence to Dr. N.A. Shadick, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA. E-mail: nshadick@partners.org. Full Release Article. For details see Reprints/Permissions at jrheum.org. Accepted for publication June 25, 2013.

From the Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; Department of Psychiatry, Cambridge Health Alliance, Boston, Massachusetts; Center for Self Leadership, Oak Park, Illinois; and Department of Psychology, Massachusetts School of Professional Psychology, Boston, Massachusetts, USA. Supported by the Bristol Myers Squibb Foundation, ABBVIE, and Genentech. N.A. Shadick, MD, MPH, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; N.F. Sowell, MSW, Department of Psychiatry, Cambridge Health Alliance; M.L. Frits, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; S.M. Hoffman, PhD; S.A. Hartz, RN, MSN, CS; F.D. Booth, MSW, Center for Self Leadership; M. Sweezy, PhD, Department of Psychiatry, Cambridge Health Alliance; P.R. Rogers, MSW; R.L. Dubin, Ed.D; J.C. Atkinson, MSW; A.L. Friedman, MSW; F. Augusto, PhD, Center for Self Leadership; C.K. Iannaccone, MPH; A.H. Fossel, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; G. Quinn, Department of Psychology, Massachusetts School of Professional Psychology; J. Cui, PhD; E. Losina, PhD, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; R.C. Schwartz, PhD, Center for Self Leadership. Address correspondence to Dr. N.A. Shadick, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA. E-mail: nshadick@partners.org. Full Release Article. For details see Reprints/Permissions at jrheum.org. Accepted for publication June 25, 2013.

From the Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; Department of Psychiatry, Cambridge Health Alliance, Boston, Massachusetts; Center for Self Leadership, Oak Park, Illinois; and Department of Psychology, Massachusetts School of Professional Psychology, Boston, Massachusetts, USA. Supported by the Bristol Myers Squibb Foundation, ABBVIE, and Genentech. N.A. Shadick, MD, MPH, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; N.F. Sowell, MSW, Department of Psychiatry, Cambridge Health Alliance; M.L. Frits, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; S.M. Hoffman, PhD; S.A. Hartz, RN, MSN, CS; F.D. Booth, MSW, Center for Self Leadership; M. Sweezy, PhD, Department of Psychiatry, Cambridge Health Alliance; P.R. Rogers, MSW; R.L. Dubin, Ed.D; J.C. Atkinson, MSW; A.L. Friedman, MSW; F. Augusto, PhD, Center for Self Leadership; C.K. Iannaccone, MPH; A.H. Fossel, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; G. Quinn, Department of Psychology, Massachusetts School of Professional Psychology; J. Cui, PhD; E. Losina, PhD, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; R.C. Schwartz, PhD, Center for Self Leadership. Address correspondence to Dr. N.A. Shadick, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA. E-mail: nshadick@partners.org. Full Release Article. For details see Reprints/Permissions at jrheum.org. Accepted for publication June 25, 2013.

From the Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; Department of Psychiatry, Cambridge Health Alliance, Boston, Massachusetts; Center for Self Leadership, Oak Park, Illinois; and Department of Psychology, Massachusetts School of Professional Psychology, Boston, Massachusetts, USA. Supported by the Bristol Myers Squibb Foundation, ABBVIE, and Genentech. N.A. Shadick, MD, MPH, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; N.F. Sowell, MSW, Department of Psychiatry, Cambridge Health Alliance; M.L. Frits, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; S.M. Hoffman, PhD; S.A. Hartz, RN, MSN, CS; F.D. Booth, MSW, Center for Self Leadership; M. Sweezy, PhD, Department of Psychiatry, Cambridge Health Alliance; P.R. Rogers, MSW; R.L. Dubin, Ed.D; J.C. Atkinson, MSW; A.L. Friedman, MSW; F. Augusto, PhD, Center for Self Leadership; C.K. Iannaccone, MPH; A.H. Fossel, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; G. Quinn, Department of Psychology, Massachusetts School of Professional Psychology; J. Cui, PhD; E. Losina, PhD, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; R.C. Schwartz, PhD, Center for Self Leadership. Address correspondence to Dr. N.A. Shadick, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA. E-mail: nshadick@partners.org. Full Release Article. For details see Reprints/Permissions at jrheum.org. Accepted for publication June 25, 2013.

From the Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; Department of Psychiatry, Cambridge Health Alliance, Boston, Massachusetts; Center for Self Leadership, Oak Park, Illinois; and Department of Psychology, Massachusetts School of Professional Psychology, Boston, Massachusetts, USA. Supported by the Bristol Myers Squibb Foundation, ABBVIE, and Genentech. N.A. Shadick, MD, MPH, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; N.F. Sowell, MSW, Department of Psychiatry, Cambridge Health Alliance; M.L. Frits, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; S.M. Hoffman, PhD; S.A. Hartz, RN, MSN, CS; F.D. Booth, MSW, Center for Self Leadership; M. Sweezy, PhD, Department of Psychiatry, Cambridge Health Alliance; P.R. Rogers, MSW; R.L. Dubin, Ed.D; J.C. Atkinson, MSW; A.L. Friedman, MSW; F. Augusto, PhD, Center for Self Leadership; C.K. Iannaccone, MPH; A.H. Fossel, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; G. Quinn, Department of Psychology, Massachusetts School of Professional Psychology; J. Cui, PhD; E. Losina, PhD, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; R.C. Schwartz, PhD, Center for Self Leadership. Address correspondence to Dr. N.A. Shadick, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA. E-mail: nshadick@partners.org. Full Release Article. For details see Reprints/Permissions at jrheum.org. Accepted for publication June 25, 2013.

From the Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; Department of Psychiatry, Cambridge Health Alliance, Boston, Massachusetts; Center for Self Leadership, Oak Park, Illinois; and Department of Psychology, Massachusetts School of Professional Psychology, Boston, Massachusetts, USA. Supported by the Bristol Myers Squibb Foundation, ABBVIE, and Genentech. N.A. Shadick, MD, MPH, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; N.F. Sowell, MSW, Department of Psychiatry, Cambridge Health Alliance; M.L. Frits, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; S.M. Hoffman, PhD; S.A. Hartz, RN, MSN, CS; F.D. Booth, MSW, Center for Self Leadership; M. Sweezy, PhD, Department of Psychiatry, Cambridge Health Alliance; P.R. Rogers, MSW; R.L. Dubin, Ed.D; J.C. Atkinson, MSW; A.L. Friedman, MSW; F. Augusto, PhD, Center for Self Leadership; C.K. Iannaccone, MPH; A.H. Fossel, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; G. Quinn, Department of Psychology, Massachusetts School of Professional Psychology; J. Cui, PhD; E. Losina, PhD, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; R.C. Schwartz, PhD, Center for Self Leadership. Address correspondence to Dr. N.A. Shadick, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA. E-mail: nshadick@partners.org. Full Release Article. For details see Reprints/Permissions at jrheum.org. Accepted for publication June 25, 2013.

From the Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; Department of Psychiatry, Cambridge Health Alliance, Boston, Massachusetts; Center for Self Leadership, Oak Park, Illinois; and Department of Psychology, Massachusetts School of Professional Psychology, Boston, Massachusetts, USA. Supported by the Bristol Myers Squibb Foundation, ABBVIE, and Genentech. N.A. Shadick, MD, MPH, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; N.F. Sowell, MSW, Department of Psychiatry, Cambridge Health Alliance; M.L. Frits, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; S.M. Hoffman, PhD; S.A. Hartz, RN, MSN, CS; F.D. Booth, MSW, Center for Self Leadership; M. Sweezy, PhD, Department of Psychiatry, Cambridge Health Alliance; P.R. Rogers, MSW; R.L. Dubin, Ed.D; J.C. Atkinson, MSW; A.L. Friedman, MSW; F. Augusto, PhD, Center for Self Leadership; C.K. Iannaccone, MPH; A.H. Fossel, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; G. Quinn, Department of Psychology, Massachusetts School of Professional Psychology; J. Cui, PhD; E. Losina, PhD, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; R.C. Schwartz, PhD, Center for Self Leadership. Address correspondence to Dr. N.A. Shadick, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA. E-mail: nshadick@partners.org. Full Release Article. For details see Reprints/Permissions at jrheum.org. Accepted for publication June 25, 2013.

From the Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; Department of Psychiatry, Cambridge Health Alliance, Boston, Massachusetts; Center for Self Leadership, Oak Park, Illinois; and Department of Psychology, Massachusetts School of Professional Psychology, Boston, Massachusetts, USA. Supported by the Bristol Myers Squibb Foundation, ABBVIE, and Genentech. N.A. Shadick, MD, MPH, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; N.F. Sowell, MSW, Department of Psychiatry, Cambridge Health Alliance; M.L. Frits, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; S.M. Hoffman, PhD; S.A. Hartz, RN, MSN, CS; F.D. Booth, MSW, Center for Self Leadership; M. Sweezy, PhD, Department of Psychiatry, Cambridge Health Alliance; P.R. Rogers, MSW; R.L. Dubin, Ed.D; J.C. Atkinson, MSW; A.L. Friedman, MSW; F. Augusto, PhD, Center for Self Leadership; C.K. Iannaccone, MPH; A.H. Fossel, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; G. Quinn, Department of Psychology, Massachusetts School of Professional Psychology; J. Cui, PhD; E. Losina, PhD, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; R.C. Schwartz, PhD, Center for Self Leadership. Address correspondence to Dr. N.A. Shadick, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA. E-mail: nshadick@partners.org. Full Release Article. For details see Reprints/Permissions at jrheum.org. Accepted for publication June 25, 2013.

From the Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; Department of Psychiatry, Cambridge Health Alliance, Boston, Massachusetts; Center for Self Leadership, Oak Park, Illinois; and Department of Psychology, Massachusetts School of Professional Psychology, Boston, Massachusetts, USA. Supported by the Bristol Myers Squibb Foundation, ABBVIE, and Genentech. N.A. Shadick, MD, MPH, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; N.F. Sowell, MSW, Department of Psychiatry, Cambridge Health Alliance; M.L. Frits, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; S.M. Hoffman, PhD; S.A. Hartz, RN, MSN, CS; F.D. Booth, MSW, Center for Self Leadership; M. Sweezy, PhD, Department of Psychiatry, Cambridge Health Alliance; P.R. Rogers, MSW; R.L. Dubin, Ed.D; J.C. Atkinson, MSW; A.L. Friedman, MSW; F. Augusto, PhD, Center for Self Leadership; C.K. Iannaccone, MPH; A.H. Fossel, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; G. Quinn, Department of Psychology, Massachusetts School of Professional Psychology; J. Cui, PhD; E. Losina, PhD, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; R.C. Schwartz, PhD, Center for Self Leadership. Address correspondence to Dr. N.A. Shadick, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA. E-mail: nshadick@partners.org. Full Release Article. For details see Reprints/Permissions at jrheum.org. Accepted for publication June 25, 2013.

From the Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; Department of Psychiatry, Cambridge Health Alliance, Boston, Massachusetts; Center for Self Leadership, Oak Park, Illinois; and Department of Psychology, Massachusetts School of Professional Psychology, Boston, Massachusetts, USA. Supported by the Bristol Myers Squibb Foundation, ABBVIE, and Genentech. N.A. Shadick, MD, MPH, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; N.F. Sowell, MSW, Department of Psychiatry, Cambridge Health Alliance; M.L. Frits, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; S.M. Hoffman, PhD; S.A. Hartz, RN, MSN, CS; F.D. Booth, MSW, Center for Self Leadership; M. Sweezy, PhD, Department of Psychiatry, Cambridge Health Alliance; P.R. Rogers, MSW; R.L. Dubin, Ed.D; J.C. Atkinson, MSW; A.L. Friedman, MSW; F. Augusto, PhD, Center for Self Leadership; C.K. Iannaccone, MPH; A.H. Fossel, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; G. Quinn, Department of Psychology, Massachusetts School of Professional Psychology; J. Cui, PhD; E. Losina, PhD, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; R.C. Schwartz, PhD, Center for Self Leadership. Address correspondence to Dr. N.A. Shadick, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA. E-mail: nshadick@partners.org. Full Release Article. For details see Reprints/Permissions at jrheum.org. Accepted for publication June 25, 2013.

From the Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; Department of Psychiatry, Cambridge Health Alliance, Boston, Massachusetts; Center for Self Leadership, Oak Park, Illinois; and Department of Psychology, Massachusetts School of Professional Psychology, Boston, Massachusetts, USA. Supported by the Bristol Myers Squibb Foundation, ABBVIE, and Genentech. N.A. Shadick, MD, MPH, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; N.F. Sowell, MSW, Department of Psychiatry, Cambridge Health Alliance; M.L. Frits, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; S.M. Hoffman, PhD; S.A. Hartz, RN, MSN, CS; F.D. Booth, MSW, Center for Self Leadership; M. Sweezy, PhD, Department of Psychiatry, Cambridge Health Alliance; P.R. Rogers, MSW; R.L. Dubin, Ed.D; J.C. Atkinson, MSW; A.L. Friedman, MSW; F. Augusto, PhD, Center for Self Leadership; C.K. Iannaccone, MPH; A.H. Fossel, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; G. Quinn, Department of Psychology, Massachusetts School of Professional Psychology; J. Cui, PhD; E. Losina, PhD, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; R.C. Schwartz, PhD, Center for Self Leadership. Address correspondence to Dr. N.A. Shadick, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA. E-mail: nshadick@partners.org. Full Release Article. For details see Reprints/Permissions at jrheum.org. Accepted for publication June 25, 2013.

From the Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; Department of Psychiatry, Cambridge Health Alliance, Boston, Massachusetts; Center for Self Leadership, Oak Park, Illinois; and Department of Psychology, Massachusetts School of Professional Psychology, Boston, Massachusetts, USA. Supported by the Bristol Myers Squibb Foundation, ABBVIE, and Genentech. N.A. Shadick, MD, MPH, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; N.F. Sowell, MSW, Department of Psychiatry, Cambridge Health Alliance; M.L. Frits, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; S.M. Hoffman, PhD; S.A. Hartz, RN, MSN, CS; F.D. Booth, MSW, Center for Self Leadership; M. Sweezy, PhD, Department of Psychiatry, Cambridge Health Alliance; P.R. Rogers, MSW; R.L. Dubin, Ed.D; J.C. Atkinson, MSW; A.L. Friedman, MSW; F. Augusto, PhD, Center for Self Leadership; C.K. Iannaccone, MPH; A.H. Fossel, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; G. Quinn, Department of Psychology, Massachusetts School of Professional Psychology; J. Cui, PhD; E. Losina, PhD, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; R.C. Schwartz, PhD, Center for Self Leadership. Address correspondence to Dr. N.A. Shadick, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA. E-mail: nshadick@partners.org. Full Release Article. For details see Reprints/Permissions at jrheum.org. Accepted for publication June 25, 2013.

From the Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; Department of Psychiatry, Cambridge Health Alliance, Boston, Massachusetts; Center for Self Leadership, Oak Park, Illinois; and Department of Psychology, Massachusetts School of Professional Psychology, Boston, Massachusetts, USA. Supported by the Bristol Myers Squibb Foundation, ABBVIE, and Genentech. N.A. Shadick, MD, MPH, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; N.F. Sowell, MSW, Department of Psychiatry, Cambridge Health Alliance; M.L. Frits, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; S.M. Hoffman, PhD; S.A. Hartz, RN, MSN, CS; F.D. Booth, MSW, Center for Self Leadership; M. Sweezy, PhD, Department of Psychiatry, Cambridge Health Alliance; P.R. Rogers, MSW; R.L. Dubin, Ed.D; J.C. Atkinson, MSW; A.L. Friedman, MSW; F. Augusto, PhD, Center for Self Leadership; C.K. Iannaccone, MPH; A.H. Fossel, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; G. Quinn, Department of Psychology, Massachusetts School of Professional Psychology; J. Cui, PhD; E. Losina, PhD, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; R.C. Schwartz, PhD, Center for Self Leadership. Address correspondence to Dr. N.A. Shadick, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA. E-mail: nshadick@partners.org. Full Release Article. For details see Reprints/Permissions at jrheum.org. Accepted for publication June 25, 2013.

From the Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; Department of Psychiatry, Cambridge Health Alliance, Boston, Massachusetts; Center for Self Leadership, Oak Park, Illinois; and Department of Psychology, Massachusetts School of Professional Psychology, Boston, Massachusetts, USA. Supported by the Bristol Myers Squibb Foundation, ABBVIE, and Genentech. N.A. Shadick, MD, MPH, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; N.F. Sowell, MSW, Department of Psychiatry, Cambridge Health Alliance; M.L. Frits, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; S.M. Hoffman, PhD; S.A. Hartz, RN, MSN, CS; F.D. Booth, MSW, Center for Self Leadership; M. Sweezy, PhD, Department of Psychiatry, Cambridge Health Alliance; P.R. Rogers, MSW; R.L. Dubin, Ed.D; J.C. Atkinson, MSW; A.L. Friedman, MSW; F. Augusto, PhD, Center for Self Leadership; C.K. Iannaccone, MPH; A.H. Fossel, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; G. Quinn, Department of Psychology, Massachusetts School of Professional Psychology; J. Cui, PhD; E. Losina, PhD, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; R.C. Schwartz, PhD, Center for Self Leadership. Address correspondence to Dr. N.A. Shadick, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA. E-mail: nshadick@partners.org. Full Release Article. For details see Reprints/Permissions at jrheum.org. Accepted for publication June 25, 2013.

From the Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; Department of Psychiatry, Cambridge Health Alliance, Boston, Massachusetts; Center for Self Leadership, Oak Park, Illinois; and Department of Psychology, Massachusetts School of Professional Psychology, Boston, Massachusetts, USA. Supported by the Bristol Myers Squibb Foundation, ABBVIE, and Genentech. N.A. Shadick, MD, MPH, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; N.F. Sowell, MSW, Department of Psychiatry, Cambridge Health Alliance; M.L. Frits, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; S.M. Hoffman, PhD; S.A. Hartz, RN, MSN, CS; F.D. Booth, MSW, Center for Self Leadership; M. Sweezy, PhD, Department of Psychiatry, Cambridge Health Alliance; P.R. Rogers, MSW; R.L. Dubin, Ed.D; J.C. Atkinson, MSW; A.L. Friedman, MSW; F. Augusto, PhD, Center for Self Leadership; C.K. Iannaccone, MPH; A.H. Fossel, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; G. Quinn, Department of Psychology, Massachusetts School of Professional Psychology; J. Cui, PhD; E. Losina, PhD, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; R.C. Schwartz, PhD, Center for Self Leadership. Address correspondence to Dr. N.A. Shadick, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA. E-mail: nshadick@partners.org. Full Release Article. For details see Reprints/Permissions at jrheum.org. Accepted for publication June 25, 2013.